8 Things to Know About Having Your Ovaries Removed to Prevent Cancer

If Angelina Jolie is doing it...should you?

Angelina Jolie. You say the name and one phrase comes to mind: women's health. Sure, she's the wife of Brad Pitt, mother to tons of adorable babies, and a stellar actor and director. But these days she's also the face bringing some of our most important issues to the forefront of the news, and helping women take control of their own health.

In 2013, she had a preventive double mastectomy after testing positive for the BRCA1 gene mutation, an alteration in DNA sequences that gives you an 87 percent chance of developing breast cancer, says James Delmore, MD, director of gynecologic oncology at the University of Kansas School of Medicine, Wichita and chair of the gynecologic oncology subcomittee for the American Congress of Obstetricians and Gynecologists. She revealed she had been planning to go under the knife again to remove her ovaries and fallopian tubes (the mutation signals a 40 to 50 percent chance of developing ovarian cancer), but according to a recent New York Times Op-Ed she wrote, that surgery was recently bumped up after discovering a number of elevated inflammatory markers, which could be a sign of early cancer. So instead of being operated on "down the road," Angelina had the surgery now.

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If you have a family or personal history of cancer and Angelina's story has you wondering whether or not you should be looking into a risk-reducing surgery, here's what you need to know first.

1. Angelina Jolie does not represent the overall female population. She acted on a testing result and family history (Angelina lost both her mother, grandmother and aunt to cancer). Because of those two factors, her risk of developing cancer down the road was quite high. But the average person has a 1 in 70 chance of being diagnosed with ovarian cancer.

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2. Having a genetic mutation (like Angelina did) plays a big role in your decision-making process. If you don't have a BRCA1 or BRCA2 mutation, then there really isn't a reason to panic, unless there's a strong family history of breast or ovarian cancer, says Delmore. Of course, there is still a possibility that you could develop cancer at some point in your life—nothing is ever foolproof—but without those two factors, your risk is much, much lower.

3. Testing is expensive...and not always covered by insurance. Before surgery is even on the table, genetic sequencing through a blood test is a must. And sadly, it doesn't come cheap. In order to fully sequence genes for both the BRCA1 and BRCA2 mutation, it costs between $3,000 and $3,500, says Delmore. If you want insurance to kick in, there needs to be a significant risk that the results would be positive—meaning a family history is critical, and the doc will need to provide paperwork that you have it. If you don't, you're going to need your credit card to cover the costs.

4. But there is a way to make it cheaper. Again, this is where family history comes into play. If your mom has a mutation, for example, it's likely that yours will occur in a similar place, explains Delmore. "If there's a mutation, the report that we get is the equivalent of an address," he says. "It'll tell us the type of mutation and where it's located in the gene." To make things cheaper, you can take your moms report and have that specific "address" sequenced on you. The doctors will easily be able to search for the mutation—it's like looking for a misspelled word in a book—and your out-of-pocket costs could be only a few hundred dollars versus a few thousand.

5. "Sooner rather than later" is key for this type of operation. In order to reap the biggest benefits from a preventive surgery like this one, Delmore says its best to do it in your early 40s, rather than waiting until something precancerous or cancerous has developed. It'll knock your risk of developing ovarian cancer down by 99 percent (because, again, nothing's foolproof). But getting it done so young makes the emotional side of this decision that much harder. Think about it: If you're tested for the mutation in your mid- to late- 30s and haven't had children yet—but want to—are you willing to find alternative methods to motherhood, or take your chances without the surgery? Talking with your doctor before you get the test results will help you keep a clear head about what options are best for you.

6. Surgery isn't the only answer. If you're a 22-year-old woman who hasn't been pregnant, for example, docs likely wouldn't leap to the operating table. Instead, "we'll recommend that you take birth control pills, or some type of hormonal contraceptive, until you're ready to be pregnant because using birth control pills for 10 years in your lifetime tends to reduce your risk of ovarian cancer, even if you are BRCA positive," says Delmore. "Being on the Pill inhibits ovulation, which provides a protective effect."

7. There are cons to going under the knife. Remember, this is an invasive operation and your body will change. Not only will you be ending your capability to bear children, but you'll also be forced into menopause, which essentially halts the flow of estrogen in your body. When that happens, "unless that person is put on hormone replacements, you're opening yourself up to issues with heart disease, sexual dysfunction, osteoporosis, and anything else that estrogen is helpful in reducing or preventing," says Delmore. Developing a proactive post-surgery treatment plan with your doctor will help you find a quality of life you're both content with.

8. The test may be readily available in the near future. With this subject making such waves toward women taking charge of their health, one has to wonder how soon everyone will be able to get tested—even if they don't have the funds to cover the costs. According to Delmore, that reality may not be far off. "My guess would be that at some point in the not-too-distant future, there will be the ability to have your entire genome sequenced at birth at a really inexpensive cost," he says. "So you or your parents would know right away if you're at risk for cardiovascular disease, cancer, Alzheimer's and more, and that could potentially steer you down a different path for how you want to live your life." You'd still need to make the decision of whether you want to know, but at least the option may soon be available.